Doctors Fall Short in Screening Young Athletes

< Nov. 16, 2011 > -- Although the American Heart Association (AHA) has long recommended that teen athletes be screened for heart problems before they hit the playing field, a new study found that less than half of doctors are following those guidelines.

The guidelines were written to help doctors and coaches detect heart problems early on in young athletes. More than 7 million high school students participate in sports across the U.S., and each year, one out of every 30,000 to 50,000 of them will die from sudden cardiac death, according to the AHA.

The AHA first released its recommendations in the mid-1990s and affirmed them in 2007, offering a 12-point screening document for health care providers to use in evaluating a youngster's heart health.

Few in the know

Researchers at the University of Washington in Seattle surveyed more than 1,100 doctors and nearly 320 high school athletic directors in Washington state. They found that less than half of the doctors and just 6 percent of athletic directors even knew about the AHA screening guidelines. And none of the athletic directors said their schools required physicals aimed at assessing an athlete's risk for sudden cardiac death.

The AHA guidelines consist of 12 items for doctors to check when evaluating a young athlete. Eight of the items are questions about personal and family history - asking about past incidences of chest pain or fainting, for instance. The remaining four items are part of a physical examination - checking for a heart murmur or Marfan syndrome, for instance. Marfan syndrom affects the connective tissues and can cause problems with the heart, major blood vessels, and other organs and structures. Based on the findings, a doctor may then refer a young patient to a heart specialist for a more detailed exam.

One main cause of sudden cardiac death in young athletes is hypertrophic cardiomyopathy, a condition in which the heart muscle becomes thickened. Heart rhythm abnormalities can also be a cause.

Incomplete picture

The current study, which was presented last weekend at the AHA's annual meeting in Orlando, Fla., also found that many doctors skip some of the questions listed in the guidelines. Twenty-eight percent failed to ask young athletes whether they had ever experienced chest pain during exercise, and 67 percent didn't ask about a family history of heart disease.

AHA President Gordon F. Tomaselli, M.D., says he was disappointed by the study findings. "Doctors are not asking the right questions or doing the proper physical exams," he says.

Dr. Tomaselli encourages parents to stay involved in their kids' sports activities. "Parents can and should be engaged with the doctors and coaches - particularly if there is a concerning [medical] history," he says.

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What Is Hypertrophic Cardiomyopathy?

In hypertrophic cardiomyopathy, the muscle mass of the left ventricle of the heart is thicker than normal, or the wall, or septum, between the two ventricles becomes enlarged. These abnormalities obstruct blood flow from the left ventricle.

The thickened muscle or septal wall can also affect one of the leaflets of the mitral valve, which separates the left atrium and the left ventricle. The valve leaflet becomes leaky, allowing blood to move backward from the left ventricle into the left atrium, instead of forward to the body.

Children with hypertrophic cardiomyopathy may have symptoms that increase with exertion or symptoms may be unpredictable. These are common symptoms:

Shortness of breath on exertion

Dizziness

Fainting

Chest pain

Abnormal heart rhythms

Always talk with your health care provider to find out more information.

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